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Sunday, March 9, 2014
Possible Cancer, My Options?
I’m on the internet tonight searching for similar cases as my diagnosis. I was originally diagnosed with severe diverticulitis and on heavy antibiotics for 17 days. A follow up colonoscopy was performed and a 1” polyp was discovered and removed. The result was a fragmented discolored tan hemorrhagic tissue that was diagnosed as not cancerous, but advanced precancerous tubulovillous adenoma. The recommendation was to see if the polyp returns in 6 months and then consider the options. Should I consider becoming proactive and aggressive to get ahead of the condition...have a colon resection to remove the diverticulitis area that is healing, but still inflamed; along with removing around this new area? What are the percentages that this will actually become cancer?
The risk of colon cancer in a polyp depends on size and type of polyp. There is 20-25% chance that a tubulovillous adenoma will contain colon cancer in it. The risk of later developing colon cancer from having a history of tubulovillous adenomas is not really known, but it sounds as though you will have continued follow-up and the development of any new polyps will be found at early stages. Colon cancer must come from polyps, so if polyps are removed periodically there isn’t much chance of developing colon cancer.
The decision to have a colonic resection for either or both conditions will rest with you and your physician. It is highly unlikely that any surgeon will perform surgery until the inflammation from your diverticulosis is completely resolved; your risk of complications will be very high prior to resolution. Waiting a while seems prudent. Since the margins on the polyp are unknown (was the entire polyp removed?), complete removal should be considered. If you are having a hemicolectomy for diverticulosis then that polyp area will be removed.
If there are cancer cells within that polyp, they are small in number and resection should be the cure, with or without a six month waiting period. The risk of developing a large tumor in your colon should be less than the risk of developing bowel complications from surgery performed in the setting of infection.
Joanna M Brell, MD
Formerly, Assistant Professor of Medicine
School of Medicine
Case Western Reserve University